DIABETES PACKET



DIABETES CLINICAL PACKET Name: Carly Lauraine

Please answer all questions in your own words. list your references at the end of each section.

A.) Medical Terminology

1. Describe the primary function of the following endocrine glands

a. Adrenal gland – Secrete hormones that control the body's metabolism, body characteristics, and chemicals in the blood. Responsible for the body's response to stress. Secretes cortisol and adrenaline for reaction during emergencies. Makes aldosterone that affects salt levels and blood pressure.

b. Hypothalmus – Controls involuntary body functions such as sleep and appetite. Controls pituitary gland. Stimulates hunger, thirst, sleep, body temperature.

c. Ovaries – Secrete hormones that influence female characteristics. Stimulated by pituitary hormones that make oestrogen and progesterone.

d. Pancreas – Makes and secretes insulin (hormone) that regulates the amount of glucose in the body.

e. Pituitary gland – Produces hormones that influence the other endocrine glands. Has influence over growth, metabolism, and regeneration. Makes ADH, prolactin, growth hormone, and oxytocin.

f. Testes – Secrete hormones that influence male characteristics. Stimulated by pituitary hormones to make testosterone.

g. Thymus – Has a role in the body's immune system

h. Thyroid – Produces hormones that stimulate heat production in the body, bone growth, and metabolism, as well as energy. Makes thyroxine

References: (1) American Medical Association Website.

2. Provide definitions for the following terms:

a. Endocrinopathy – A disease of an endocrine gland.

b. Hyperinsulinism – Above normal rise of insulin in blood.

c. Acromegaly – Condition where pitutary gland produces too much growth hormone in the body.

d. diabetes insipidus –Kidneys are unable to conserve water while they filter blood, amount of water conserved is controlled by vasopressin characterized by excessive thirst, cry skin, excessive urination.

e. SIADH – (Syndrome of Inappropriate Antidiuretic Hormone) Characterized by hyperosmolarity of urine, Excess vasopressin secretion occurs, renal and adrenal functioning is normal.

f. Hypothyroidism – Deficiency in thyroid secretion, can be caused by thyroid failure, pituitary TSH deficit, or deficiency of thyrotropin releasing hormone.

g. Hyperthyroidism – Excess Thyroid secretion, especially T3 ( thriiodothyronine) and T4 ( thyroxone which control heart rate, body temperature, metabolism, calcitonin production.

h. Hyperparathyroidism – Excessive secretion of PTH by the parathyroid glands. Primary (HPT) is caused by either a parathyroid adenoma, cancer, or hyperplasia or parathyroid glands. Secondary (HPT) is associated with renal failure or renal transplantation.

i. Hypoparathyroidism –Occurs when there is a deficiency of PTH due to inactive hormones, remonal or damage to glands, or a delayed renal response. Chronic condition where lifelong treatment of vitamin D and calcium supplements are essential.

j. Cushing syndrome –Disease state characterized by excess cortisol, caused by hormonal stimulation (extrinsic/excessive) of adrenal cortex thought to be by a tumor of the anterior pituitary gland, adrenal hyperplasia, or the use of exogenous cortisol.

References: (1) Nutrition Therapy and Pathophysiology: pg 473 (2) Nutrition and Diagnosis-Related Care: pg 520-596.

B.) Diabetes, Disease and Conditions:

Please answer all Sections using your own words.

For each of the following you are given the definition and etiology. You should provide the pathophysiology of disease process and progression; disease impact on nutrition status; and dietary recommendations when needed:

a. Definition

b. Etiology

c. Describe the physical changes specific to the disease process and progression (pathogenesis).

d. Explain how the disease impacts the patient’s nutritional status (in some cases there will be no impact.)

e. Is a modified diet recommended for this condition? If so what is the diet prescription?

Refer to GI Packet, GI-related diseases and conditions, hemorrhoids, for an example

|1. |Type 1 Diabetes |

| |a. |Definition: A metabolic disease involving altered carbohydrate, protein and fat metabolism in which high blood sugar results |

| | |from inadequate insulin secretion by the pancreas. Most commonly diagnosed between ages of 5 and 20. |

| |b. |Etiology: Immune mediated type 1 diabetes results when an autoimmune attack destroys the beta cells of the pancreas. There |

| | |may be genetic or environmental (exposure to viruses or toxins) factors associated with development of type 1 diabetes. |

| | |Idiopathic type 1 diabetes is also caused by destruction of beta cells but does not appear to have autoimmune involvement. |

| |c. |Pathogenesis: In the absence of insulin this is the flow of events that will take place if not addressed in patiend: muscle and |

| | |adipose tissue use of glucose is inhibited, hyperglycemia, glycosuria (osmotic diuresis), water and electrolyte loss, |

| | |dehydration, hemoconcentration, peripheral circulatory failure, hypotension, decreased renal blood flow, anuria, coma/death. The|

| | |following actions ususally performed by insulin are inhibited: decreasing hepatic glucose output at the same time increase |

| | |glucose oxidation, glycogen deposition, lisogenesis, protein synthesis, cell replication. |

| | |Glycosylation – Covalently adding a carbohydrate to another molecule. |

| | |Acidosis – Metabolic acidosis results from an increased amount of ketogenesis in the liver. |

| | |Ketones – Normal metabolic products of lipid metabolism within the liver, usually oxidized in muscle. |

| |d. |Nutritional Status: Effects of insulin deficiency are: increased hepatic glucose output (leading to hyperglycemia, glucosuria, |

| | |osmotic diuresis, polyuria, and dehydration), decreased glucose uptake by cells (leading to intracellular glucose deficiency, |

| | |and polyphagia), decreased triglyceride synthesis and increased lipolysis (both leading to and increased in blood fatty acids, |

| | |ketosis, and metabolic acidosis), decreased amino acid uptakte by cells (leading to increased gluconeogenesis), increased |

| | |protein degredation (leading to muscle wasting and weight loss). |

| |e. |MNT: Goals of MNT for diabetes: attain and maintain optimal metabolic outomces (normal blood glucose levels, blood pressure and |

| | |lipid profile that decrease the risk of vascular disease) prevent and treat chronic complications of diabetes through lifestyle |

| | |and diet changes, address individual nutritional needs, maintain eating pleasure of patientTreatment goals: avoid hyperglycemia |

| | |and slow the advancement of complications of disease, maintain normal glucose range. Individuals count on daily insulin |

| | |distribution into body in addition to nutrition therapy and daily physical activity. Recommendations for total fat, saturated |

| | |fat, cholesterol, fiber, vitamins and minerals are the same as with a normal healthy population. Protein: 15-20% of daily kcal |

| | |with animal and plant sources included. At lease 130g carbohydrates are recommended each day. Meals and snacks should be |

| | |consumed in a way that insulin can aid in the regulation of blood glucose levels. A variety of heart healthy foods should be |

| | |included in diet. Include plenty of fiber, and whole grains. Decrease intake of friend and creamed foods. Include omega-3 |

| | |fatty acids that will aid in the regulartion of blood lipid and inflammation responses. MUFA and carbohydrates should account |

| | |for 60-70% energy intake. CHO intake should remain between 45% and 65% of total energy intake every day. Saturated fat ................
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